NPIMap

Organization Active NPI

Apple Grove Treatment Center

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Henderson, NV
National Provider Identifier
1346429495
Registry record updated Oct 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
APPLE GROVE TREATMENT CENTER
Practice address
2060 Waverly Cir
Henderson, NV 89014-4593
Phone
(702) 369-0396
NPI assigned
Oct 25, 2007
Last updated
Oct 25, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Icia Reid Sandulak, BSWNPI 1831384379
Title
Director
Phone
(702) 369-0396

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X NV Primary

Addresses

Primary practice location

2060 Waverly Cir
Henderson, NV 89014-4593

Mailing address

368 Placer Creek LN
Henderson, NV 89014-4557
Phone (702) 369-0396

Other identifiers 1

IdentifierTypeStateIssuer
32-2D00000XMedicaidNV

National Provider Directory

National Provider Directory
Tax ID family
Apple Grove Treatment Center5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1346429495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "368 PLACER CREEK LN",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890144557",
            "telephone_number": "702-369-0396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 WAVERLY CIR",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890144593",
            "telephone_number": "702-369-0396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APPLE GROVE TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-25",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "REID SANDULAK",
        "authorized_official_first_name": "ICIA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "702-369-0396",
        "authorized_official_credential": "BSW"
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32-2D00000X",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.